Assessment of a behavioral scale for the measurement of fear, anxiety and stress in dogs visiting the veterinary practice

Validated, reliable instruments for assessing canine stress behaviors during veterinary visits are crucial in mitigating escalating behavioral responses, thereby maximizing patient welfare, facilitating accurate diagnoses and enhancing staff safety. Although various behavioral assessment tools have been developed, few have been evaluated specifically for the veterinary context. This study addresses this deficit by evaluating the Spectrum of Fear, Anxiety and Stress, (FAS, Fear Free® 2022) an eight-item scale, graduating from 0 to 5, designed to assess canine fear, stress and anxiety during veterinary visits. An online survey featuring 14 video recordings of dogs undergoing mock veterinary examination was distributed to 79 participants, including dog owners, veterinarians, behavior experts and trainers. This study assessed inter- and intra-rater reliability, concurrent validity, and ease of use. Scores at either end of the spectrum had the highest percentage of correct responses (FAS 0 Relaxed; 51.90% incorrect, FAS 4 Severe signs; 44.30% incorrect), while mid-range scores were more challenging for participants to correctly identify (FAS 0–1 Perked/Interested/Anxious; 72.78% incorrect). Behavior experts and owners significantly differed in their ability to assess some moderate and severe signs (FAS 3 Moderate signs; p = 0.0025, FAS 4a Flight; p = 0.0355), suggesting that experience in assessing dog behavior may impact the ability to identify fear, stress and anxiety correctly. Inter-rater reliability was excellent (ICC = 0.99 with 95% confidence interval [0.99–1.00]), intra-rater reliability was very good (ICC = 0.83 with 95% confidence interval [0.80–0.86]), and a strong correlation was found between participant FAS scores and cumulative scores on the Lincoln Canine Anxiety Scale (ρ = 0.811, p =<0.001, n = 79), suggesting good concurrent validity. Thematic analysis praised the scale's visual aspects, but revealed challenges related to overlapping categories and unfamiliar numbering. The results of this research support further development, including some minor design adjustments and sufficient participant training, of the FAS Spectrum as a valid and reliable behavioral assessment tool for evaluating acute stress in dogs visiting the veterinary practice, in order to provide reliable behavioral assessment to facilitate stress reduction in clinic. Your article is being processed as a regular item to be included in a regular issue. • Extreme fear, anxiety, and stress behaviors are easier to identify correctly. • Mild signs of escalating fear, anxiety, and stress are harder to identify correctly. • Veterinarians are less reliable when rescoring videos of mild escalating FAS signs. • Behavior experts assess moderate FAS scores more accurately than dog owners. • The FAS spectrum is reliable but could improve with further adaptation.